Treatment & CareNeuroscienceNeurosurgeryConditions TreatedDural Arteriovenous Fistulas

Dural Arteriovenous Fistulas Treatment

Providing Treatment for Vascular Malformations

We treat a wide variety of rare, neurological diseases, including dural arteriovenous fistulas (dAVF). This is a vascular condition involving abnormal connections between arterial and venous branches in the brain covering, called the dura. This vascular malformation can result in arterial ruptures, causing brain bleeding and hemorrhage, as well as other neurological problems. Symptoms depend on the location and drainage pattern of the dAVF, but some people remain asymptomatic and are only diagnosed incidentally. When present, symptoms may be mild to life-threatening.

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What Are Dural Arteriovenous Fistulas?

AVFs can occur anywhere in the body, but those which occur in the brain or spinal cord in tough outer covering, called the dura mater, are dural arteriovenous fistulas (dAVFs). To understand arteriovenous fistulas, it’s helpful to understand the anatomy of the blood vessels in the brain. The brain has 3 types of blood vessels: arteries, veins, and capillaries. In an AVF, there is an abnormal connection between one or more arteries and the veins. Normally, blood should flow from the arteries and connect to the vein through the capillaries, but in AVFs, the capillaries are bypassed and then receive less blood.

Symptoms of Dural Arteriovenous Fistulas

Symptoms may be aggressive or benign, but some people do not experience any symptoms at all. The more aggressive a dAVF, the more likely the patient is to suffer brain bleeding (stroke). The reason for variation from one patient to the next is because the location and drainage pattern of the dAVF play a role in the development of symptoms.

Neurological symptoms of dAVFs may include:

Bruit (an unusual sound your doctor hears through a stethoscope made from unusual blood flow)
Severe headache
Pulsatile tinnitus (constant ringing in the ears)
Difficulty seeing
Seizures
Parkinsonism
Coordination issues
Personality changes, such as apathy
Nausea and vomiting
Dementia

You should make an appointment with your doctor if you notice any signs of a problem or experience any symptoms of a seizure or stroke.

Causes of Dural Arteriovenous Fistulas

Doctors still don’t know what causes most dAVFs, and they are not inherited. Some may result from head trauma, like blunt force trauma, infection, previous brain surgery, or a tumor such as a benign meningioma. Many authorities think dAVFs arise from progressive narrowing of the brain’s venous sinuses which route blood from the brain en route to the heart. Most people develop a dAVF later in life, roughly from 50 to 60 years old, but they can occur even in children.

Diagnosis of Dural Arteriovenous Fistulas

During a physical and neurological exam, your doctor may recommend diagnostic tests to determine if you have a dAVF. Initial evaluation for dAVF usually involves cross-sectional imaging tests of the head, such as a magnetic resonance imaging (MRI) scan.

Imaging tests used to diagnose dAVF include:

Computerized tomography (CT) head scan: This shows your neurologist if there is fluid buildup in the brain’s venous system, which may be caused by a dAVF.
MRI scan: This is the gold standard for diagnosis of a dAVF, as it can establish its shape and the extent of the condition.

Once your neurologist has administered the imaging tests and has located the vascular malformation, they will order a catheter-based cerebral angiography to make a definitive diagnosis of a dAVF. This defines the anatomy of the external carotid arteries, and the structure of the blood vessels. It also determines whether the patient has heart disease as well as checks if there is narrowing or blockage in the dural sinus and if any of the affected veins are dilated, and how much.